Ben R Davies

The Hypertriglyceridemic Waist, Waist-to-Height Ratio, and Cardiometabolic Risk

OBJECTIVE To investigate whether the hypertriglyceridemic waist (HW) phenotype and waist-to-height ratio (WHTR) are associated with cardiometabolic disorders in children and adolescents. STUDY DESIGN This was a cross-sectional design study. Anthropometry, biochemical variables, and cardiorespiratory fitness were assessed in 234 participants (122 girls) aged 10-19 years from Bedfordshire, United Kingdom. The HW phenotype was defined as a waist circumference ≥90(th) percentile for age and sex, and triglyceride concentrations ≥1.24 mmol/L, and a high WHTR defined as >0.5. ANCOVA and logistic regression were used in the analysis. RESULT In participants with the HW phenotype, the odds of having high cardiorespiratory fitness (mL/kg/min) were lower (0.045; 95% CI 0.01, 0.42), and the odds of having low high-density lipoprotein cholesterol (4.41; 1.50, 12.91), impaired fasting glucose (3.37; 1.06, 10.72), and ≥1 (4.78; 1.32, 17.29) and ≥2 risk factors (7.16; 2.38, 21.54) were higher than those without the phenotype. Those with a high WHTR had higher odds of having low high-density lipoprotein cholesterol (2.57; 1.11, 5.95), high diastolic blood pressure (3.21; 1.25, 8.25), and ≥2 risk factors (5.57; 2.05, 15.17) than those with normal WHTR. CONCLUSION The HW phenotype may be a better simple marker than WHTR for identifying children and adolescents at risk for cardiometabolic disorders.

Randomised feasibility trial of a teaching assistant led extracurricular physical activity intervention for 9 to 11 year olds: Action 3:30

BackgroundExtracurricular programmes could provide a mechanism to increase the physical activity (PA) of primary-school-aged children. The aim of this feasibility study was to examine whether the Action 3:30 intervention, which is delivered by teaching assistants, holds promise as a means of increasing the PA of Year 5 and 6 children.MethodsA cluster randomised feasibility trial was conducted in 20 primary schools. Ten schools received the Action 3:30 intervention and 10 schools were allocated to the control arm. The intervention was 40 one-hour sessions, delivered twice a week by teaching assistants. The proportion of participants recruited per school was calculated. Session delivery and session attendance was calculated for intervention schools. Weekday and after-school (3.30 to 8.30 pm) moderate to vigorous intensity physical (MVPA) was assessed by accelerometer at baseline (T0), during the last few weeks of the intervention (T1) and four months after the intervention had ended (T2). The costs of delivering the intervention were estimated.ResultsFive intervention schools ran all 40 of the intended sessions. Of the remaining five, three ran 39, one ran 38 and one ran 29 sessions. Mean attendance was 53%. The adjusted difference in weekday MVPA at T1 was 4.3 minutes (95% CI -2.6 to 11.3). Sex-stratified analyses indicated that boys obtained 8.6 more minutes of weekday MVPA than the control group (95% CI 2.8 to 14.5) at T1 with no effect for girls (0.15 minutes, 95% CI -9.7 to 10.0). There was no evidence that participation in the programme increased MVPA once the club sessions ceased (T2). The indicative average cost of this intervention was £2,425 per school or £81 per participating child during its first year and £1,461 per school or £49 per participating child thereafter.ConclusionsThe effect of the Action 3:30 intervention was comparable to previous physical activity interventions but further analysis indicated that there was a marked sex difference with a positive impact on boys and no evidence of an effect on girls. The Action 3:30 intervention holds considerable promise but more work is needed to enhance the effectiveness of the intervention, particularly for girls.Trial registrationISRCTN58502739

Increasing children’s physical activity through a teaching-assistant led extracurricular intervention: process evaluation of the action 3:30 randomised feasibility trial

BackgroundMany children do not engage in recommended levels of physical activity (PA), highlighting the need to find ways to increase children’s PA. Process evaluations play an important role in improving the science of randomised controlled trials. We recently reported the results of the Action 3:30 cluster randomised feasibility trial illustrating higher levels of moderate to vigorous intensity PA among boys but not girls. The aim of this paper is to report the process evaluation results including intervention fidelity, implementation, context and how intervention components and trial design could be improved before proceeding to a definitive RCT.MethodsChildren’s session enjoyment was assessed every two weeks. Reasons for non-attendance were provided by questionnaire at the end of the intervention. Post intervention interviews were held with participating teaching assistants (TAs) and school key contacts (KCs), and focus groups were conducted with children in all 10 intervention schools. Interviews and focus groups examined how recruitment and session attendance might be improved and established which elements of the programme that were and were not well received.ResultsData indicated good intervention fidelity with TA’s adopting enjoyment-focussed teaching styles and the sessions improving children’s skills and self-esteem. Several positive aspects of implementation were identified, including high session variety, the opportunity to work in teams, the child-led sessions and the engaging leader style. In terms of context there was evidence that TA’s faced difficulties managing challenging behaviour and that further training in this area was needed. TAs and KCs felt that recruitment could be improved by providing taster sessions during PE lessons and clarifying the days that the clubs would run at the point of recruitment. The programme could be improved to enhance interest for girls, by including training for managing disruptive behaviour and making some activities more age-group appropriate.ConclusionsAction 3.30 showed promise but could be improved by ensuring age appropriate activities, providing more appeal to girls and improving recruitment through taster sessions and early establishment of days of the week it is to be offered on.Trial registrationISRCTN58502739

The triglyceride to high-density lipoprotein ratio identifies children who may be at risk of developing cardiometabolic disease.

It is important to develop simple, reliable methods to identify high‐risk individuals who may benefit from intervention. This study investigated the association between the triglyceride to high‐density lipoprotein cholesterol (TG/HDL) ratio and cardiometabolic risk, cardiorespiratory fitness and physical activity in children.

Delivery and Receipt of a Self-Determination-Theory-Based Extracurricular Physical Activity Intervention: Exploring Theoretical Fidelity in Action 3:30

The implementation, fidelity, and receipt of a self-determination-theory-based after-school physical activity intervention (Action 3:30) delivered by teaching assistants (TAs) was examined using a mixed-methods process evaluation. Physical activity motivation and need satisfaction were reported by 539 participants at baseline, the end of intervention, and 4-month follow-up. Pupil- and TA-reported autonomy-support and teaching efficacy were collected alongside interviews with 18 TAs and focus groups with 60 participants. Among intervention boys there were small increases in identified, introjected, and external motivation and no differences in need satisfaction. Among girls, intrinsic and identified motivation and autonomy and relatedness were lower in the intervention group. Qualitative evidence for fidelity was moderate, and boys reported greater need satisfaction than girls. TAs provided greater structure than involvement or autonomy-support and felt least efficacious when facing school-based challenges. The findings highlight the refinements needed to enhance theoretical fidelity and intervention effectiveness for boys and girls.

Frailty assessment in primary health care and its association with unplanned secondary care use: a rapid review

Background The growing frail, older population is increasing pressure on hospital services. This is directing the attention of clinical commissioning groups towards more comprehensive approaches to managing frailty in the primary healthcare environment. Aim To review the literature on whether assessment of frailty in primary health care leads to a reduction in unplanned secondary care use. Design & setting A rapid review involving a systematic search of Medline and Medline In-Process. Method Relevant data were extracted following the iterative screening of titles, abstracts, and full texts to identify studies in the primary or community healthcare setting which assessed the effect of frailty on unplanned secondary care use between January 2005–June 2016. Results The review included 11 primary studies: nine observational studies; one randomised controlled trial (RCT); and one non-randomised controlled trial (nRCT). Eight out of nine observational studies reported a positive association between frailty and secondary care utilisation. The RCT and nRCT reported conflicting findings. Conclusion Older people identified as frail in a primary healthcare setting were more likely to be admitted to hospital. Based on the limited and equivocal trial evidence, it is not possible to draw firm conclusions regarding appropriate tools for the identification and management of frail older people at risk of hospital admission.

PW 1462 Can first aid education support public use of urgent care services? a qualitative study

Background Despite a range of urgent care services being available in the UK, public attendance at Emergency Departments has increased markedly, placing a significant burden on these resources. Self-care and first aid education may reduce the need to attend urgent care services. Understanding public decision-making regarding the use of such services can inform whether educational measures are likely to be effective. Objectives To understand the perspectives of service users and providers of urgent care services regarding who attends, where and when they attend, and the potential role of first aid education to influence that decision-making. Methods We conducted semi-structured interviews with recent users of urgent care services or their carers, ran two focus groups with past users of services, and interviewed healthcare practitioners who either work in urgent care services or refer to such services. Interviews were recorded, transcribed and analysed thematically. Findings 11 service users or carers participated in interviews, and 12 in two focus groups. 23 healthcare practitioners were interviewed. Thematic analysis identified seven groups of urgent care services who may have the potential to benefit from first aid education. Recommendations included developing the content and delivery of first aid education to include management of minor injuries as well as life threatening ones, targeting education to specific groups of frequent users, supporting the public through first aid education to know where and when to access local urgent care services, and supporting ability to self-care. Conclusions First aid education may have a role to play in supporting decision-making about use of urgent care services. The content and delivery of the education package would need development and subsequent evaluation. Policy implications Commissioners of urgent care services and first aid education programmes should consider first aid education as a potential intervention to support urgent care service use and reduce demand.

Dietary glycaemic index and glycaemic load in relation to body mass index, body composition and waist circumference in post pubertal adolescents from Bedfordshire

Glycaemic index (GI) and Glycaemic load (GL) have been positively associated with body mass index (BMI) and obesity related cardiometabolic risk factors in adults, but limited research exists for such relationships in adolescent populations. The associations of GI and GL with adiposity measures were assessed in 14–19 year old, postpubertal adolescents (n = 47) from Bedfordshire, U.K. Data were collected as part of ongoing research studies; the SIRENS study (study of insulin resistance factors using exercise and nutritional strategies) and the CROSSROADS study (cross sectional study: risk of adolescent disease). Dietary intake was recorded using 3 day weighed food diaries and analysed using Compeat1 nutritional analysis software. Macronutrient intake, as well as GI and GL were adjusted for energy intake using the residuals method. Other measures included BMI, body fat percentage (%BF), waist circumference (WC) and a maximal test of cardiorespiratory fitness (VO2 peak).